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General NPI Number Information
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NPI Number | 1528975224
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Entity Type | Individual
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Provider Name | KAISHA ALEXUS MOORE OTR/L
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Gender | Female
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Dates
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Enumeration Date | 08/26/2026
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Last Update Date | 08/26/2026
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Provider Practice Location Address
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Address Line | 301 MEDICAL PARK DR STE 202A
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City | CONCORD
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State | NC
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Zip | 28025-3059
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Country | US
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Telephone | 704-403-2627
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Fax |
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Provider Business Mailing Address
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Address Line | 2121 KUMARA RD APT 204
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City | CHARLOTTE
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State | NC
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Zip | 28262-0309
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Country | US
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Telephone | 704-403-2627
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 18620
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 18620
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License Number State | NC
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